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COMMUNITY HEALTH POLICIES and PROGRAMMES Publication: October 2019 © Cover Photo: Tremeau/Fonds Français Muskoka ANALYSIS REPORT

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COMMUNITY HEALTH POLICIES and PROGRAMMES Publication: October 2019 © Cover Photo: Tremeau/Fonds Français Muskoka ANALYSIS REPORT ANALYSIS REPORT COMMUNITY HEALTH POLICIES AND PROGRAMMES Publication: October 2019 © cover photo: Tremeau/Fonds Français Muskoka ANALYSIS REPORT COMMUNITY HEALTH POLICIES AND PROGRAMMES ACRONYMS AC Care community agents (in French: Agents EBV Epstein-Barr virus communautaires - Sénégal) ECD Early Childhood Development ACPP Prevention and Promotion Community Actor (in French: Acteur Communautaire de Prévention et de Promotion EMTCT Elimination of mother-to-child transmission of VIH - Sénégal) FGM Female Genital Mutilation ACT Artemisinin-based combination therapy GAC Global Affairs Canada (ex-CIDA) ANC Antenatal Care HPV Human papilloma virus APP Agents for Promotion and Prevention (in French: iCCM integrated Community Case Management Agents pour la Promotion et la Prévention - Niger) IMCI Integrated Management of Childhood Illness ARI Acute Respiratory Infection IPTp Intermittent preventive treatment in pregnancy ASACO Community Health Organizations (Mali) KMC Kangaroo Mother Care ASBC Community-based health workers (in French : Agent de santé à base communautaire - Burkina Faso) LGA Local Government Area (Nigeria) BEPC First Secondary school diploma in francophone LLI(T)N Long-lasting insecticidal(-treated) nets education systems - 14/15 years old (in French: Brevet d’Etudes du Premier Cycle) LMIS Logistics management and information system CAC Community organization unit (in French: Cellule MAM Moderate acute malnutrition d’animation communautaire - DRC) M&E Monitoring and Evaluation CBC Community Birth Companion (The Gambia) MNP Micronutrient powders C4D Communication for Development MOH Ministry Of Health CHA Community Health Assistant (Liberia) MUAC Mid Upper Arm Circumference CHEW Community Health Extension Worker (Nigeria) ORS Oral Rehydratation Solutions CHO Community Health Officer (Ghana) PBF Performance-Based Financing CHV Community Health Volunteer (Ghana, Liberia) PHC Primary Health Care (The Gambia) CHN Community Health Nurse (Gambia, The) PHU Public Health Unit (Sierra Leone) CHW Community Health Worker PMTCT Prevention of mother-to-child transmission of VIH CMHO Community Mental Health Officers (Ghana, Cameroun) RDT Rapid diagnostic tests (malaria) CORP Community Oriented Resource Person (Nigeria) RECO Community volunteer (RDC) CPN Consultation Prénatale RUTF Ready-to-Use Therapeutic Food CSCOM Community Health Center (Mali) SAM Severe acute malnutrition DEF End of Primary school diploma in Mali - 8/9 ans SCP Seasonal malaria chemo-prevention (in French: Diplôme d’Etudes Fondamentales) UNFPA United Nations Population Fund (UNFPA) DFID Department for International Development TBA Traditional birth attendant (in French: Sage-femme DHIS2 District Health Information Software (Version 2) traditionnelle) DOT Directly Observed Therapy VHW Village Health Worker (Gambia, The, Liberia, Guinea) DSDOM Home healthcare provider (in French: Dispensateur WCAR West and Central Africa Region de Soins à Domicile - Senegal) WHO World Health Organization 4 Community health policies and programmes CONTRIBUTORS AND ACKNOWLEDGMENTS This work was initiated and coordinated by Magali Romedenne (Community Health Specialist, UNICEF West and Central Africa Regional Office), under the oversight of René Ekpini (Health Regional Adviser, UNICEF WCARO). The desk review, data collection, analysis and reporting were carried out by Leslie Dubent (Public Health Consultant, UNICEF WCARO). The country teams of respondents were composed of staff from the Ministry of Health (MOH) and UNICEF Country Offices. These included the following members in the twenty countries:Benin : Denis Sossa (MOH), and Gilbert Vissoh, Soliou Badarou, Adama Ouedraogo (UNICEF); Burkina Faso: Neya Christelle Ouédraogo, Valérie Zombré Sanon, Daouda Akabi, Kafando Awa Ouédraogo, Yaméogo Issaka (MOH) and Denis Bakunzi Muhoza, Yemdame Bangagne (UNICEF); Cameroon: Manjo Mathilda (MOH) and Grégoire Kananda, Augustin Rashidi Maulidi Amboko (UNICEF); Central African Republic: Oscar Bekaka Youle Dobinet, Aimé Théodore Dodane (MOH), and Emmanuel Wansi, Faton Mehoundo (UNICEF); Chad: Mahamat Tidjani Ali, (MOH), and Célestin Traoré, Thomas Morban, Marie Claire Mutanda, Morgaye Gueim, Mamadou N’Diaye (UNICEF); Côte d’Ivoire: Simplice Dagnan, Mamadou Samba, Adama Sanogo Pongathie (MOH) and Bechir Aounen, Bruno Aholoukpe, Alimata Diakite Sow (UNICEF); Republic of Congo: Ludovic Gnekoumou Libaba, Gabrielle Ossenza, Daniel Mfoutou, Josh Mberi, Paul Nzaba (MOH) and Hermann Boris Didi Ngossaki, Mayeul Patrick Moukoulou Lwamba, Belem Elisabeth Kiendrebeo (UNICEF); The Gambia: Musa. M. Loum, Ebrima Bah, Modou Njai, Haddy Badjie, Kausu Bojang, Fatou O Sowe, Ousman Ceesay, Lamin B. Jawara, Modou Njie, Alhagie Sangareh, Ngally Abubacarr Sambou, Baba Galleh Jallow, Lamin Ceesay, Modou Njie (MOH) and Mariama Janneh (UNICEF); Ghana: Charles Adjei Acquah, Koku Awoonor (MOH), and Daniel Yayemain (UNICEF); Guinea: Facinet Yattara, Emmanuel Roland Malano (MOH); Guinea Bissau: Pedro Vaz (MOH), and Jean-Claude Mubalama, Umaro Ba, Sofia De Oliviera, Zaira Rodriguez (UNICEF);Liberia : Tamba Boima (MOH), and Anthony Yeakpalah, Anju Puri (UNICEF); Mali: Maiga Oumou Maiga, Plea Boureima (MOH), and Samba Diarra, Sekou Oumar Diarra (UNICEF); Mauritania: Aly Cheibany Cheikh Ahmed (MOH), and Kalidou Samba Ba (UNICEF); Niger: Soughia Mariama, Hamidou Atta (MOH), and Mariam Sylla Diène, Awa Seck, Fatima Hachimou (UNICEF); Nigeria: E. Meribole, Anthony Adoghe (MOH) and Fatima Cheshi (UNICEF); Democratic Republic Of Congo: Moise Kakule Kanyere, John Tony Bakukulu (MOH) and Tony Byamungu, Rie Takesue (UNICEF); Senegal: Khady Seck, Fatou Berete Ndiaye Niang, Amy Mbacké, Alioune Tall, Anta Diaw, Sadiya Aidara (MOH), Hassane Yaradou(USAID), Judith Tsague (MEASURE), and Aida Gadiaga (UNICEF); Sierra Leone: Alpha Bangura, Joseph Bangura (MOH), and Hailemariam Legesse (UNICEF); Togo: Abdoukarim Naba Mouchedou (MOH), and Marie Therese Guigui, Akouété Afanou (UNICEF). UNICEF resources supported the funding for the coordination of the work. In addition, financial support for the consultancy work, as well as its publication was received from The French Muskoka Fund. This financial support is gratefully acknowledged. UNICEF - West and Central Africa 5 TABLE OF CONTENTS List of figures 8 List of tables 9 List of boxes 9 Executive summary 10 Context 11 Objectives 12 Methods 13 Results 14 1. COORDINATION AND POLICY SETTING 14 1.1. Policy and strategic documents 14 1.2. Key principles 14 1.3. Situation analysis 15 1.4. Coordination mechanisms 15 1.5. Population coverage of the program 16 1.6. Communication and social mobilization 16 2. COSTING AND FINANCING 18 2.1. Costing 18 2.2. National budget 18 2.3. Cost of services 18 2.4. Donors funding 18 3. HUMAN RESOURCES 19 3.1. Status as described in policy documents 19 3.2. Multiplicity of CHWs types 21 3.3. Status and means of recognition 23 3.4. Remuneration 25 3.5. Retention strategy 26 3.6. Educational background and training 27 3.7. Density 28 4. GENDER RESPONSIVENESS 30 4.1. Policy review 30 4.2. Gender balance in recruitment 30 4.3. Gender-specific advantages/disadvantages 30 4.4. Gender-responsiveness of policy documents 31 5. PACKAGE OF SERVICES 32 5.1. Definition of package of services in policy documents 32 5.2. Antenatal and newborn care 32 5.3. Childhood illnesses 34 5.4. Adolescent health 36 5.5. Family planning 37 5.6. HIV 38 5.7. Tuberculosis 39 5.8. Community-based surveillance 39 6 Community health policies and programmes TABLE OF CONTENTS 6. SUPPLY CHAIN MANAGEMENT 41 6.1. Supply plans 41 6.2. Integration into national supply system 41 6.3. Appropriate medicines for community case management 42 7. REFERRAL AND COUNTER-REFERRAL 43 7.1. Definition of referral and counter-referral mechanisms in policy documents 43 7.2. Existence of clearly define mechanisms 43 7.3. Counter-referral 43 8. COMMUNICATION AND SOCIAL MOBILIZATION 44 8.1. Communication 44 8.2. Community engagement 44 8.3. Accountability framework 44 8.4. Community capacities 44 8.5. Multisectoral dynamic at community levels 45 9. SUPERVISION AND PERFORMANCE QUALITY ASSURANCE 46 9.1. Policy review 46 9.2. Supervision and performance quality assurance practices in countries 46 10. MONITORING AND EVALUATION AND COMMUNITY HEALTH INFORMATION SYSTEMS 49 10.1. Policy review 49 10.2. Monitoring framework 49 10.3. Integration of community health data into national information system 49 10.4. Research plans 50 Discussion 51 Conclusion 53 References 54 ANNEX A - Country Profiles 56 ANNEX B - Regional Profile 76 ANNEX C - Tables of main community health criteria in West and Central African countries 78 ANNEX D - Questionnaire 105 UNICEF - West and Central Africa 7 LIST OF FIGURES Figure 1- Overall number of available official strategic community health documents in 20 WCAR countries 14 Figure 2- Number of WCAR countries addressing the community health key principles in policy documents, by level 15 Figure 3-Civil servant and contractual CHWs in WCAR countries 19 Figure 4- Volunteer CHWs in WCAR countries 19 Figure 5- CHWs salary and motivation in WCAR countries 20 Figure 6- Distribution of community workers statuses in WCAR countries 23 Figure 7- Number of WCAR countries implementing the different modes of remuneration for each category of workers 25 Figure 8- Number of WCAR countries according to the educational level required, for each category of workers 27 Figure 9- Distribution of number of WCAR countries according to training duration ranges for category 1 workers 27 Figure 10- Distribution of refresher training
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